OKLAHOMA CITY - Hundreds of main street pharmacies are struggling to stay in business.
Now, they're fighting what they call a "dark secret" in the prescription drug industry.
According to the Oklahoma Pharmacists Association, nearly 85 percent of prescriptions written by a doctor are processed by what's called a Pharmacy Benefit Manager (PBMs).
They claim those managers are basically unregulated and operate as the "middle man" in prescription drug claims processing.
Ladoris Broome is on dialysis and moves a little slow some days.
That's why she loves coming to Thrifty Pharmacy for a personal touch.
"They realize that and they hurry up and fill my prescription and give it to me," she said. "And they tell me what all I need to know about it and I'm out the door."
The Oklahoma Pharmacists Association (OPhA) claims nearly 600 state pharmacies could soon go out of business.
"The PBSs are not going to negotiate fairly," said Josh Sheffield, president of the OPhA. "They want to crush small business in Oklahoma."
PBMs are a handful of large companies that process the majority of America's prescription drug claims.
Local pharmacists say they're forced into blind contracts with these PBMs and are losing money.
Greg Huenergardt, who operates a small pharmacy in Shattuck, says low reimbursements forced him to stop carrying oxycodone, which became a major inconvenience for a customer suffering with chronic pain.
"We had to pass her on," he said. "Well the next pharmacy that was able to dispense that, because of the fee structure, was about 42 miles away."
Sen. Rob Standridge is also a pharmacist and co-authored House Bill 2100.
He says below-cost reimbursements are hurting patients across the state.
"Who loses in that situation? The patient," he said. "The senior citizen in the nursing home that is dying of cancer cannot have oxycodone because neither Walgreens, Walmart or any other pharmacy in this state can afford to have it on their shelves."
Standridge and Rep. David Derby say the bill would regulate PBMs and make actual drug costs more transparent to pharmacies.
Dani Lynch, with Thrifty Pharmacy, said, "I buy the oxycodone for $50 a bottle and they're willing to reimburse me $4."
But Lynch will continue absorbing the loss for a hospice patient she knows who desperately needs that drug.
"He is worth it," she said. "But you can't stay in business."
The Pharmaceutical Care Management Association responded, saying, "The Federal Trade Commission examined similar Board of Pharmacy legislation and found it would make 'collusion easier and increase prescription drug prices if the Pharmacy Board obtains and discloses PBMs competitively sensitive information to pharmaceutical manufacturers, pharmacists, and pharmacies.' PBMs are regulated through their contracts with their employer and health plan clients in Oklahoma. In addition, mail-service pharmacies serving patients in Oklahoma are licensed by the Board of Pharmacy."
CVS Caremark responded to the bill, saying, "As a pharmacy benefit manager, CVS Caremark is focused on providing our clients with opportunities to improve health outcomes for their members, while also managing costs. CVS Caremark offers our PBMs clients tremendous value, transparency and cost-effective services. We work with our clients to develop plan designs that meet their needs and promote the use of clinically appropriate and cost-effective medications for their members."
"In addition, CVS Caremark follows all applicable state and federal regulations when it is acting as a PBMs and when it acts as pharmacy provider. Moreover, it is factually inaccurate to suggest that PBMs, and the pharmacies they operate, are unregulated."
Half a dozen states have recently passed similar legislation to HB 2100.